E-Warranty Registration Form | Philippines

1
Full Name* This field is required.As per identity card
2
Any Primary Government ID (Passport / LTO Driver's License / UMID / SSS / Philhealth)* This field is required.
3
Date of Birth* This field is required.
Date
Day
Month
Year
4
Gender* This field is required.
Male
Female
5
Mobile* This field is required.
6
E-mail* This field is required.
7
Address* This field is required.
Address
Street Address
City
State
Postcode
Philippines
Please Select
Afghanistan
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Romania
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Rwanda
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eSwatini
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Isle of Man
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Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
Please upload your original receipts (s).* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
9
Please upload your original receipts (s).* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
10
Purchased from* This field is required.
Electrical Stores
Online Stores
Others
11
Electrical Stores* This field is required.
True Value
True Home
Rustan's Department Store
12
Online Stores* This field is required.
Medklinn Online Store
Lazada
Una Ricci
The Nest Genie
BeautyMnl
Birch Registry
Edamama
Zalora
13
Others* This field is required.
14
Date of Purchase* This field is required.
Date
Year
Month
Day
15
Number of Unit(s)* This field is required.
Please Select
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
16
Product Model 1* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
17
Product Model 2* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
18
Product Model 3* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
19
Product Model 4* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
20
Product Model 5* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
21
Product Model 6* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
22
Product Model 7* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
23
Product Model 8* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
24
Product Model 9* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
25
Product Model 10* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
26
Product Model 11* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
27
Product Model 12* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
28
Product Model 13* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
29
Product Model 14* This field is required.
Please Select
Please Select
Autoplus
Autoplus Docking
Asens+20
Asens+40
Asens+60
Versa 25
Versa 45
Ex: 348-BB-01-12345
30
Warranty Terms & Conditions* This field is required.
31
Privacy Policy* This field is required.
32
Please verify that you are human* This field is required.
33
Email
example@example.com
Should be Empty: